Mental health articles

OF mental health care and mentally ill

Ethnicity and mental disorder

The flow of people across continents, which is an increasingly common feature of modern life, provides a clear example of how social forces can affect a person’s mental health. Many of these people will have fled unimaginable psychological and physical pain in an attempt to find respite and asylum. This group is particularly vulnerable to mental health problems. Post-traumatic stress disorder is commonly reported and the risk of suicide is also raised in this group. Within established UK communities there is evidence also of interactions between ethnicity and mental health.

For example, young Asian women have a relatively high rate of suicide which, though poorly understood, has been attributed to conflicts between parental expectations and the aspirations of children who develop in a Western culture (NHS Centre for Reviews and Dissemination 1996). However, of all the ethnic groups that make up modern Britain, the Black African-Caribbean population’s experience provides a salutary lesson on the effect of social forces on mental health. A consistent finding in the literature has been the differential experiences of African-Caribbeans in mental health services compared with others in our communities. Their care pathways are problematic and are more often characterized by compulsory admissions to hospital, police involvement prior to admission, the administration of medications by force, and contentious staff–user interactions. They are also more likely to receive a diagnosis of schizophrenia and less likely than other social groups to receive diagnoses of depression or other affective disorders. What social forces might account for these differentials? AfricanCaribbeans are afforded poorer housing, experience higher levels of unemployment and draw a lower average income per household than their white counterparts. Further, approximately one third of young black men between the ages of 20 and 24 are unemployed, and for the African-Caribbean population at large, unemployment is approximately three times greater than it is among white communities. The social model posits that the experiences of African-Caribbean communities in the UK are sufficient to engender mental health problems. However, these differentials are not just a feature of everyday life but extend into the arena of mental health care itself. For example, psychiatrists have been found to more frequently view black people as violent, and racial stereotyping of this kind (not only by psychiatrists but by mental health nurses and other staff, too), significantly influences patient management. Thus, there are community features associated with deprivation that African-Caribbean people experience, which we know affect their mental health, and there are the attitudes of some health care professionals, which compound the experience of mental ill-health.

The Sainsbury Centre for Mental Health (SCMH) has recently completed a major qualitative inquiry into this phenomenon, which they have termed ‘circles of fear’. A wide-ranging programme is needed to break these circles of fear, the main aims of which should be to: •ensure that Black service users are treated with respect and that their voices are heard; •deliver early intervention and early access to services to prevent escalation of crises; •ensure that services are accessible, welcoming, relevant and wellintegrated with the community; •increase understanding and effective communication on both sides including creating a culture that allows people to discuss race and mental health issues; and •deliver greater support and funding to services led by the Black community.

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